A Psychoanalytic Look at Recovered Memories

There has been a dramatic increase in recovered memories of sexual abuse. A continuum of influence is presented, focusing on the high degrees of influence in cults, to understand how therapists can easily influence their patients to recover memories of sexual abuse. Historical evidence is given for a better appreciation of how this present atmosphere has developed. Finally, the role played by the psychoanalyst when dealing with recovered memories is examined. Case material is presented to highlight the differences between the traumatist's and the psychoanalyst's approach.

Introduction

During the last fifteen years, there has been an explosion of recovered memories of sexual abuse. After examining how this explosion has affected the author's patients, causative factors for this explosion will be addressed. Next, a variety of conditions that might lead a patient to "recovered" memories of abuse that never occurred will be described. Finally, the paper will focus on the psychoanalyst's stance in the face of recovered memories.

I have been a clinical social worker since 1970 and, in 1984, received certification as a psychoanalyst. In the twenty-five years that I have been seeing patients, there were many times that patients came to therapy with memories of sexual abuse. These never forgotten memories of sexual abuse in childhood or during adolescence were accepted by them and by me as historical truths. In addition to this, some patients have recovered memories of sexual abuse, previously forgotten, in this clinical setting. My course, as a clinician, was to inform patients that it was hard to distinguish whether recovered memories were memories of fantasies, because unconscious wishes and fears could influence memory. Recovered memories can be viewed in the same manner as dream material—that is, as screen memories. However, I never discounted this possibility of the historical truths embedded in these memories.

During the last few years, my caseload has been affected by a new phenomenon. Since the mid-seventies, I have specialized in working with former cultists. This area of specialization has given me a rich appreciation of the power of influence. In an article published in 1989, William Goldberg and I described the plight of a family whose son had what was thought to be a unique and bizarre complaint. He had "discovered" through hypnosis that he had been sexually abused by his mother and older sister. The incredulous family denied that any such behavior ever took place; but their son refused to listen to their denials and cut off all communication with them, saying that he could not speak to such monsters. Both the therapist/cult leader and the young man traveled throughout New Jersey speaking publicly about the horrors of childhood sexual abuse. What concerned us was the fact that all of this therapist's patients appeared to be recovering from memories of childhood sexual abuse and that this therapist seemed to be encouraging her clients to break off ties with their families and to increase their tie to her as their new parental figure. Normal therapeutic boundaries appeared to be broken as this therapist seemed to control every aspect of this young man's life. His total devotion to her and dependency on her was familiar to us. It appeared to be similar to the relationship we saw between other cult leaders and followers.

We wrote this description as an example of the extent to which one cult leader went to discredit the parents of one of her members (Goldberg and Goldberg, 1989). We were used to parents telling us that their cult member children were exaggerating and distorting problems and issues from their past (minimizing the good memories and maximizing the bad ones), but had never before encountered parents who said that their child had, with the "help" of a cult leader, completely fabricated a past.

It would be unfairly biased to totally discount the idea that this young man might be telling the truth. However, we were dismayed to learn that all of this therapist's patients had memories of abuse and that this therapist appeared to be using narcissistically her patients for her own dog-and-pony show and encouraging her patients to break all ties with family members. Therefore, we hypothesized that this young man was likely to have responded to this therapist's suggestion that he had been abused.

Since that incident the author has heard the same story from many parents. Their adult son or, more commonly, daughter, announces to the family that with the help of a therapist she has recovered previously repressed memories of being sexually abused, sometimes while she was an infant, sometimes over many years, usually by her father. She presents the accusation as a fact and states that if her father denies the "fact" or gets angry, she will leave and the family will never hear from her again. Having been pre-empted from any kind of natural response, the parents are left speechless. Eventually, and almost inevitably, she does cut off ties with the parents, because it has been suggested to her by her therapist that this is an act of empowerment and growth. Contact with siblings is usually also stopped unless the brothers and sisters acknowledge the validity of the accuser's claims. Thus, the daughter (or, sometimes, son) simultaneously ensures the fact that she will hear only one version of her supposed past and cuts herself off from the very people who would be most likely to support her through a difficult period of her life. The author had no idea at the time that she first heard this story of the young man and his publicity-seeking therapist that these were the early signs of a new phenomenon and that it would be so widespread as to be given a clinical title, the False Memory Syndrome, by some clinicians and family members.

In my chapter on "Guidelines for Therapists," in the book, Recovery from Cults (Langone, 1994), I described a twenty-eight year old woman who came to see me one year after she had left her cult. When this woman was a teenager in the cult she had been seduced by the group's leader, who told her that it was G-d's will that they have sex. Believing him to be speaking for G-d, the woman entered into an ongoing secret sexual relationship with him, only to discover, many years later, that he was having a similar relationship with at least twelve of the women in the cult. This discovery propelled her to leave the cult. The young woman was filled with self-loathing and shame when she left and she sought out therapy with a woman who claimed to be an expert in the area of sexual abuse. Either being ignorant of the powerful effect of persuasion and mind control in cults or ignoring the literature on it (Lifton, 1961, Ofshe and Singer, 1986, Hassan, 1988), this previous therapist told the young woman that it was clear that she was reenacting a situation from her childhood, otherwise she would not have permitted the cult leader to abuse her in this way. She told her that, in all probability, her father had been the original perpetrator and that her memories of a happy childhood were the result of denial and repression of childhood sexual abuse. Although the patient was unable to recall any such abuse, she was placed in a group for incest survivors and was told to participate in group guided imagery exercises to help her recall the abuse that the therapist surmised was there. At first, she recollected feeling uncomfortable when an alcoholic uncle bugged her after he had been drinking. She was convinced that more memories would come in time. It was only after she attended a seminar on cults and came to understand the phenomenon of mind control (intense power of influence by a charismatic anti-social and/or narcissistic leader in a closed environment) that she recognized another plausible explanation for why she had permitted herself to be exploited by the cult leader.

The author worked with another woman who was involved with an isolationist psychotherapy cult in the Northwest. The group preached hatred of men and, by extension, of society. Through the use of group processes, every single member of this cult discovered that she had been sexually abused by her father and cut herself off from the family. Another patient, who had experienced a gang rape while in college, decided to attend a group for rape survivors in New York City. After getting a brief history of this patient, including a history of depression and of an eating disorder, the group therapist asked her if she had been sexually abused in childhood. This patient had no memory of such abuse. The therapist informed her that she had all the "classic symptoms" of someone who was sexually abused and that she probably had repressed those memories.

As Freud (Freud, 1921), Lifton (Lifton, 1961), Ofshe and Singer (Ofshe, R. and Singer, M.T., 1986) and Hassan (Hassan, 1988) explain, an authority figure can have tremendous influence over group members. The process whereby this influence can be attained will now be examined.

Authority Figure Influence on Group Members

In 1921, upon publishing Group Psychology and the Analysis of the Ego, Freud was among the first to study the powerful influence that group leaders can have over group members. In his paper, Freud referred to the contagious and regressive nature of groups described by LeBon and McDougall, but he added the dimension of intra-psychic cathartic shifts that could occur in groups. Freud described the similarity of such groups as the Catholic Church and the army with the hypnotic situation. In all of these situations, there is a leader and one or more followers. The follower obeys the leader and gives up his own superego and ego ideal as he identifies with the leader's superego. Freud also compared the psychological changes occurring in group members to changes that occur to those who fall in love. In both cases, the ego can disregard the previous standards of the superego, because it gains a sufficient amount of narcissistic support and gratification of instinctual wishes elsewhere.

After the Korean War, under assignment by the U.S. Army, Lifton Singer, West, and others studied the effects of mind control techniques on the returning POWs. They described how these soldiers had been influenced to accept communist ideology while captive. They explained how these techniques of coercive persuasion went beyond normal group influences described by Freud through the use of deliberate manipulation processes that increased guilt, shame, and anxiety in the POW’s (Singer and Ofshe, 1990). These mental health professionals were the first to describe the fact that some of the same mind control dynamics are used in modern day cults. Today there is a recognized body of literature by mental health professionals about mind control techniques used in cults.

Of course, in addition to examining the coercive techniques, the clinician must examine the vulnerability of the cult recruit. Individuals become vulnerable to cults at times of stress, particularly during periods of transition (e.g., when dealing with loss of a relationship or employment). The large majority of people who join cults do so in late adolescence or early adulthood. With puberty, there is an increase in the sexual and aggressive drives. Along with this, there is a revival of oedipal feelings and, therefore, there is a need for distancing from the oedipal objects of childhood. Parents are de-idealized and healthy young adults attempt to develop a vision of the world that is different from their parent's view. Also, during this time, there often is physical distance from the family. This distance and the concomitant feelings of separateness it engenders may trigger pre-oedipal anxiety and/or depression. Additionally, there are specific personality dynamics of late adolescence which were first described by Anna Freud—intellectualization, asceticism and idealism—which make adolescents vulnerable to cults (Freud 1966). Furthermore, the adolescent superego is highly susceptible to environmental influences as a result of parental de-identification. Therefore, this is a time of life that the group or group leader can have a powerful influence.

Adolescents and young adults also are in a period of transition and may desire a sense of community and acceptance at a time in their life when they are experiencing uncertainty and/or anxiety about their identities and their futures. Therefore, this is a stage of development wherein group membership and the new identifications made with group members can be a progressive step of separation from the object, of childhood. As mentioned previously, an adolescent becomes particularly vulnerable to cult recruitment at a time when he or she is dealing with external and/or internal losses. Those who are particularly susceptible to groups that turn out to be cults are typically those who are in order to attack the recruits' identity and belief system; and (6) pressuring recruits to meet a new standard of perfection. These influence techniques attack the recruit's identity structure, formed from identifications made with important figures in the recruit's life. That is, without conscious awareness of this process, individuals are induced to let go of their original identity and take on a new cultic identity and, by doing so, enter into a dissociative state. This cultic identity enables the recruit to better cope with this recruitment process.

In viewing this situation psycho dynamically, it could be said that with the absence of an anchor in the past, recruits defend against feeling anxious, overwhelmed, exhausted, and confused by forming an identification with the cult leader—identification with the aggressor. Anna Freud coined "identification with the aggressor" in The Ego and the Mechanisms of Defense, to describe how a child "introjects some characteristic of an anxiety object and so assimilates an anxiety experience which he has just undergone" (Freud, 1966, p. 113). This defense was not only used to describe a process of childhood, but was seen as a defensive maneuver used at later periods of life when the individual was undergoing high levels of stress. For example, the defense of identification with the aggressor was later used to understand how Jews imprisoned in concentration camps sought out discarded insignias and torn shreds of SS uniforms with which to adorn their rags (West and Martin, 1994).

If this process is prolonged, the new cultic personality, initially formed as a role played in response to stressful circumstances, will be superimposed upon the original personality which, while not completely forgotten, will be enveloped within the shell of the new cultic personality (West and Martin, 1994). This new cultic identification encapsulates the general regression that occurs in recruits to cults. The pre-oedipal cult world is seen as black and white and objects as good and evil. This view, which defines the cult world as the only true path and the outside world (often including family and friends) as satanic, further binds the recruit to the cult. This also has implications for memory of past relationships and events. Typically, over time, life prior to the cult begins to be seen in a more negative light. Furthermore, there is a sense of omnipotence gained by sharing with the all-powerful cult leader (mother). This sense of omnipotence is experienced as euphoria by the recruit. The boundaries have blurred and the recruit's sense of individuality is weakened.

Cult members become aware of the positive effect of belonging to a single-minded community. Whitsett describes how this sense of belonging can be used as a powerful tool to keep recruits in cults (Whitsett, pp. 363-375). However, the pressure for uniformity has a regressive influence on the ego, precluding any type of critical assessment of this coercive and highly suggestive experience. Recruits are actively discouraged from differentiating their own thoughts and feelings from those of the group. This single-mindedness is reinforced through a strict system of reward and punishment. There is constant pressure to be obedient to the cult leader. If recruits have doubts or go against the cult leader's wishes, they are humiliated or, worse, threatened with excommunication—which cult members come to believe is being damned to Hell. Furthermore, their doubt is defined as a reflection of their personal problems, not as reflection of deficiencies within the leader or the ideology, Therefore, by punishing any expression of doubt, the leader induces cult members to become more and more dependent on receiving his approval through obedient behavior. In this way, ego functions that interfere with group functions are attacked and diminished. The cult member becomes child-like and suggestible. Therefore, in order to continue to feel good the recruit must continually be locked into an idealizing transference the cult leader, which never ends and never is interpreted.

It was understandable how anti-social and/or narcissistic cult leaders will use suggestion of childhood sexual abuse as a technique for further separating cult members from their parents. It was harder to understand how well-meaning therapists could suggest this to their patients The suspicion is that some therapists are not aware of how much influence they have over their patients. Only a very small minority of therapists consciously and deceptively employs some of the techniques used by cult leaders. However, there is a continuum of influence and, although therapists do not have the degree of influence over patients that cult leaders have over their followers, all therapists should recognize that their behavior and attitudes do have some degree of influence on their patients. Before this concept is developed further, an historical overview of recovered memories will be explored.

Historical Overview of Recovered Memories

In the late nineteenth century, while working with his first patients, who were displaying hysterical symptoms, Freud suspected that the causative factors for these symptoms were sexual seductions from early childhood. When his patients reported recovered memories of childhood sexual seductions, he believed them without qualification (Freud, 1893-1895). However, in analyzing his own dreams, investigating children's behavior, and in gaining an appreciation of the power of transference, it became clear to Freud that human behavior was much more complex than he had originally believed. Freud began to theorize that memory could be influenced by unconscious sexual and aggressive fantasies. He noted that hysterical symptoms, like dreams, represented fantasized wishes and conflicts about these wishes rather than only traumatic memories. Symptoms were based on psychic reality rather than simply objective reality. Therefore, he considered the possibility that some—not all—childhood memories were screen memories rather than being historical in every detail. Freud developed the more complex theory that children have sexual as well as aggressive feelings from early life and these basic feelings stimulate fantasies and, therefore, can have an impact on memory. Freud never abandoned the idea that children could be, and often were, sexually abused. However, Freud began to credit children with a complex mental capacity by recognizing their ability to wish, invent, and fantasize, and he recognized that this ability shaped and influenced memory (Freud, 1905).

Freud developed the seduction theory prior to his formulation of his ideas about transference. As he developed his ideas about transference, he further was able to see how transference reactions could influence historical reports. That is, he began to consider that some of his patients, under sway of positive transference feelings, might unconsciously be reporting material that they felt would please him and, therefore, give him the material for which they felt he was looking. Along with this insight, Freud began to see transference reactions as a defense against conscious awareness of intrapsychic conflicts. Therefore, for Freud, identifying and understanding transference reactions became a central route along with dreams, to gaining an understanding of the patient's true history. Unfortunately, many in the mental health community viewed Freud's insights as an indication that all memories of childhood sexual experiences were fantasies. There was a tendency for many clinicians to look intrapsychically to the exclusion of outward reality. This attitude led to the mental health community's virtual abandonment of victims of childhood sexual abuse.

One of the positive outgrowths of the feminist movement in the '70s and '80s was the exposure of the reality of spousal and child abuse. Women talking to one another in groups shared painful experiences of abuse. They demanded services for abused women and children, (e.g., shelters for battered women, counseling for rape victims, and counseling for victims of sexual and physical abuse) (Herman, 1992). The recognition that sexual abuse of children is much more prevalent than had previously been acknowledged was a necessary rectification of a problem that existed in the profession and in our society for many years.

Social work always has been a profession sensitive to environmental issues. In the late '70s, as social work training incorporated the findings of the feminist movement, social work students were trained by individuals concerned about abuse issues. After reports of abuse had been discounted for decades, social workers saw the importance of believing children and women who had been abused. In 1984, Masson wrote The Assault on Truth: Freud's Suppression of the Seduction Theory in which he posited that Freud cowardly retreated from his seduction theory because it was criticized by the medical community. This book was cited by some social workers, among others, to assert that Freud was bowing to society's need to deny the truth and discount women and children by disavowing his trauma theory. By endorsing Freud's seduction theory these individuals moved from a more complex to a more simplistic notion of the causative factors of mental illness (Saari, 1994).

The influence of the recovery movement in the mental health field was also felt in the 1980s. Kaminer points to the simplistic notions of the recovery movement (Kaminer, 1992). Unfortunately, these simplistic notions gained more widespread appeal and credibility as those "in recovery" entered various mental health fields to become therapists. The recovery movement encouraged the notions of victimization and regression by defining practically everybody as survivors who should get in touch with their "inner child." Kaminer questions:

What are the political implications of a mass movement that counsels surrender of will and submission to a higher power describing almost everyone as hapless victims of familial abuse? What are the implications of a tradition that tells us all problems can be readily solved, in a few simple steps—a tradition in which order and obedience to technique are virtues and respect for complexities, uncertainties, and existential unease are signs of failure, if not sin? The notion of selfhood that emerges from recovery . . . is essentially more conducive to totalitarianism than democracy, (p. 152)

Television talk shows and books gave victims of and leaders in the recovery movement a widespread audience.

False Memories of Sexual Abuse

As a result of the events previously described, numerous traumatized victims of sexual abuse felt less isolated and more understood. However, the terrain was fertile for the development of false memories of sexual abuse. Some clinicians became "trauma therapists," experts on abuse. The work of Fredrickson influenced therapists who reasoned fallaciously that one could presume that patients were sexually abused in childhood based upon symptomotology. In her book, Repressed Memories: A Journey to Recovery from Sexual Abuse, Fredrickson provided therapists with a checklist of aftereffects (Fredrickson, 1992). Entire clinical categories (e.g., depression, eating disorders, etc.) were interpreted as symptoms of abuse. Fredrickson also described specific methods for retrieving memories of sexual abuse, which included guided imagery, dream work, journal writing, body work, hypnosis, art therapy, and rage work (Fredrickson, 1992).

The theories of the trauma therapists had a great influence on their patients. The patient's initial idealizing transference reactions, seeing the therapist as an all-knowing expert, gave the therapists tremendous power over patients. As with the cult leaders, if the idealizing transference was never interpreted, patients were kept in a childlike, dependent position. The traumatist's "suspicion" of sexual abuse, based on a variety of symptoms, often was expressed in the first session with a patient who had come to therapy with no such memory of abuse. This early diagnosis often was supported by self-help books, such as The Courage to Heal (Bass and Davis, 1988) and Secret Survivors: Uncovering Incest and Its Aftereffects in Women (Blume, 1990), which patients were encouraged to read. These therapists typically used suggestion to "recover" lost memories of abuse. As mentioned previously, hypnotic techniques such as guided imagery, and drugs such as sodium amytal, were sometimes used to elicit supposedly repressed memories. There was no recognition that hypnosis and soporific drugs render a patient more open to suggestion. Some studies have shown that hypnosis does not necessarily help subjects to remember accurately, but that its use increases the subject's belief that what they have "remembered" is accurate (Yapko, p. 56). These therapists often placed their patients into groups for survivors of sexual abuse. Similar to the dynamics of cult groups, peer pressure and the resulting tendency towards uniformity of thought can interfere with critical thinking. Therapists would interpret dream material and physical symptoms, along with recovered memories, as scientific evidence of traumatic memories of sexual abuse and they would interpret recovered memories as scientific evidence of abuse (Yapko, 1994). Their stance was, "All recovered memories are reality."

The patients of trauma therapists, particularly those who were more anxious and suggestible, often accepted the suggestion of abuse, because it became the simple causative answer for all their problems and pain. In this way, these patients were similar to those who were recruited successfully into cults. Simple answers for life's difficulties can be very reassuring. Furthermore, Brenneis, writing in a recent JAPA article, has indicated that the anxious patient seeks comfort and direction from, and affiliation with, a perceived expert. Suggestion operates in areas of doubt and uncertainty. The force of {the therapist's} convictions creates for the patient what amounts to a stacked deck: solace and direction require affiliation, and affiliation in turn requires some measure of agreement or acceptance of the beliefs of the analyst. (Brenneis, p. 1034)

Brenneis also points out that both the therapist and the patient gain what they are seeking: The therapist gains confirmation of her/his beliefs and the patient gains "cognitive clarity and affiliation with an accepting authority figure" (Brenneis, 1035).

Ganaway states that the new belief system becomes the substitute for the symptoms that had brought the patient to the therapist. While the patient may gain a new identity and satisfy a desire for affiliation by being a member of the abuse survivor movement, the therapist has diverted the patient from an understanding of the true, more complex meaning of the symptoms and their underlying defenses (Ganaway, 1994).

Many of these patients would become increasingly angry over time. This increased anger may have been generated because these patient were not feeling better emotionally since real issues were not being addressed and, for some, there was a loss of the support system of the family. Also, contagion might exist as the patient's anger is set off exacerbated by the anger of the believing therapist and/or group members. Therapists often would join with the patients against the "abusers. They would abandon their neutral stance and encourage patients to take action against the abusers (including lawsuits). This joining with the patients' actions against the abusers, usually the parents, was fed by the countertransferential reaction to keep the anger away from the therapists (Hedges, L., 1994). Cutting off the relationship with family members also served to increase the patient's dependency on the therapist.

Hearing about these incidents was disturbing. Psychoanalysts believe that recovered memories may be reconstructions rather than exact reproductions of past events and experiences. These memories are continuously influenced by conscious and unconscious fantasies, beliefs, moods wishes, etc. (Ganaway, 1994). The patients need not be believed (traumatists were insisting), but needed to be taken seriously (Hedges 1994). Memories could be seen as metaphors for boundary violation from the past and present (Spence, 1982). Furthermore, the literature on experiments in cognitive psychology showed memory to be highly plastic and highly susceptible to influence and suggestion (Loftus, 1993]. Additionally, Ceci's research with children indicated how easily young children can be influenced to remember differently from week to week (Ceci, S.J., Ross, D.F., and Toglia, M.P., 1987). Therefore, how could recovered memories from early life be accepted as accurate without question?

Conclusions

There is no doubt that childhood sexual abuse exists. In many cases, those who have gone to trauma therapists have experienced childhood sexual abuse. However, it is problematic to discern the veracity of recovered memories of sexual abuse, particularly those memories that did not arise spontaneously within the confines of a therapeutic relationship, but which were induced through suggestion, hypnosis, soporific drugs or peer pressure. As reported in this paper, memories can easily be re-shaped by both external and internal forces. The appropriate role for the therapist is to explain this fact to the patient and to take a wait-and-see approach. As Esman states, the "empathic" acceptance of all material can lead to iatrogenic suggestion. Esman recommends that, "Neither unquestioning credulity nor categorical disbelief, but a properly scientific attitude of enlightened skepticism would seem to be in order" (Esman, 1994. Letter, JAPA, 43: 1, 195-296). Uncertainty is uncomfortable. However, both patients and therapists need to be able to tolerate complexity and uncertainty in life and resist the need for closure. It is unrealistic and harmful for patients to see their therapists as all-knowing human beings.

Of course, all of this needs to be explored in the context of the therapeutic relationship, particularly focusing on possible transference and counter transference reactions. Questions to explore might include the following: Why is this memory surfacing at this point in the therapy? Has this memory been influenced by a recent event occurring inside or outside a therapeutic session? How is the patient feeling towards the therapist and how is the therapist feeling towards the patient? What is the meaning of this memory to the patient? How does the patient expect the therapist to receive this material and how does she/he react when the therapist takes a wait-and-see approach? Certainly therapists are induced to feel that patients who suspect they were abused need us to believe them. It is important for therapists to be sensitive to all material presented in therapy sessions, especially when traumatic events are shared. However, in the face of recovered memories that formerly have been repressed, is the therapist responding empathically by automatically believing? Is it more important to believe our patients in all matters or to be the voice of reality? It has been pointed out by Galatzer-Levy that the parents' failures to respond empathically when bad things happen frequently have a more profound impact on the child than the event itself. Therefore, the therapist's desire to avoid repeating this response may lead him/her to prematurely appreciate the patient's experience of the event. As Galatzer-Levy notes, "Paradoxically, this very process may subtly repeat the parental failure to understand. It invites assumptions of understanding that the analyst may lack" (Galatzer-Levy, 3. 998). The more "empathic" response is to be a concerned, careful, and caring listener who informs the patient of the difficulty in knowing the historical truth when memories are recovered. However, as Galatzer-Levy has noted, the emphasis should be on the meaning of the recalled memory as it relates to the past, as it relates to the transference, as it relates to other experiences with important figures and events from the past, and as it relates to the patient's fantasy life. A case may illustrate some of these points.

A woman, 62 years of age, came to see the author two years after her husband's death, because she continued to feel depressed. In early sessions she quietly extolled her happy life with her husband. He was described as very "proper" and this propriety had attracted her to him. She had believed that she would feel "safe" with this successful businessman. After several sessions, she admitted with extreme shame and trepidation that she shoplifted. She seemed to come to life as she described the most recent episode, which had a cloak and dagger quality to it. I noted, from the way she described these shoplifting episodes, that they were exciting to her. However, they also appeared to fill her with shame and trepidation. I questioned whether her need was for me to see her as a criminal and punish her for engaging in such an exciting act. The patient admitted that she was externalizing her own guilt. Although she loved her husband, her life with him had been somewhat restricted. Now that he was dead, she was afraid that she was returning to her childhood impulsive ways. She was afraid that she would stop being the proper upper middle class suburban matron and turn into a whore. When I explored what being a whore signified to her, she told me that she had seen her husband as quite different from her bawdy and loud family. She really did not approve of her parents, particularly her father, who was bad tempered and a failure as a provider. Her mother saved the family from poverty by successfully running the family store. This patient described her early years as very chaotic and had never forgotten memories of sleeping with her parents until she was ten. At this point, she shared a bed with a young man who worked in her parents' store. She began wondering if she had forgotten sexual experiences while she was in bed with these adults. She wondered if she was treated like a "whore." She began to bring in dream material that included recreations of sexual experiences.

As with all patients, I told her of the difficulty of distinguishing recovered memories from fantasies. I described how children have sexual and aggressive feelings and fantasies that continue into adulthood. I let her know that I felt she clearly had been over-stimulated sexually as a child, but it was hard to know the extent of her childhood sexual abuse. (I was also aware of the libidinal gratification gained from these recalled memories, particularly now that her husband was dead.) She accepted this notion and continued to report dream material and recovered memories of childhood sexual abuse. Although I did not verify these recovered memories as historical truths, I continued to be empathic and interested in what she had to say. Furthermore, we began to understand how these recovered memories or fantasies had shaped her character. Gaining a better understanding of herself by exploring the transference, as well as the meaning of the recovered memories allowed the recovered memories to continue even though they were treated as screen memories.

As she felt less judged by me (we discovered that this was a maternal transference reaction as well as a projection of her own moralistic attitude), she became less inhibited in general. She began to see how her shame of her past and her own rich fantasy life had left her quite restricted in adulthood. In fact, she began to see her continued depression about her husband's death as, in part, stemming from her need to punish herself for her anger towards him regarding his need to have such a conservative and proper wife. As she felt less shame about her inner life, she was able to be more open and colorful and this ability was reflected in her writing. Instead of limiting her writing to scientific journals, she began working on fiction. She also stopped shoplifting, as she had less of a need to act out her conflict in this self-destructive way. The issue for this patient centered more on how she felt about her inner life than whether or not all her revived material was true. Her feelings about her inner fantasy life had a tremendous impact over her character, which was inhibited and intensely proper throughout her early and middle adulthood. Over time, my acceptance of the material from her inner life allowed her to loosen her defense of reaction formation. She became less inhibited and more able to gain access to the creative and colorful part of herself as she identified with the therapist's superego, which was less punitive than her own.

Growth occurs from the therapist's attempt to be with the patient, to see the experience from the patient's point of view and to help the patient expand her cognitive abilities, particularly by examining transference and counter transference reactions. This examination includes a toleration of ambiguity and an understanding that behavior is complex and multidetermined. This approach is more valuable than simply validating all that the patient says.

This article was originally published in Clinical Social Work, volume 25, number 1. It is reprinted with permission.

Lorna Goldberg, M.S.W., L. C. S. W., a therapist in private practice, has co-led a support group for ex-cult members with her husband, William, for over 25 years. She is on the faculty of the New Jersey Institute for Training in Psychoanalysis, where she also is the Director of the Child and Adolescent Program. Mrs. Goldberg has written extensively for social work and AFF publications. (blgoldberg@aol.com)

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